OnMedica – News – Strategies to compensate for autism could delay diagnosis and improve mental health

But they can also enhance social integration, enhance independence and employment prospects

Compensatory strategies – camouflage techniques of autism – can increase social integration, independence and job prospects, but can also increase the risk of poor mental health and delay diagnosis, suggest preliminary results, published in Lancet Psychiatry aujourd & # 39; hui.

the qualitative study* Out of 136 adults, highlights the need to sensitize clinicians to these strategies and to better support those who need them, conclude the researchers.

Autistic spectrum disorders are characterized by communication difficulties with others and by repetitive and restricted behaviors.

Among those affected, compensatory strategies may include the use of prior experience or logic to respond to social situations in order to "integrate." But autism continues on a neurocognitive level.

The authors of the study recruited 136 participants via social media and the National Autistic Society: 58 had a clinical diagnosis, 19 self-identified without a formal diagnosis; and 59 were not diagnosed or identified, but reported social difficulties.

The study examined the compensatory strategies used by the participants, whether the strategies used were similar in the diagnosed and undiagnosed, and how the compensatory strategies affected the diagnosis.

Participants were asked to complete a questionnaire of 10 questions about the autism spectrum and then a series of open questions about their social compensation strategies. They were also asked how effective and tiring their strategies were and how likely they would be to recommend them to other people in social difficulty.

The team has identified several strategies used by people with and without autism diagnosis.

These included behavioral masking such as holding true thoughts or suppressing atypical behaviors; superficial and deep compensation, such as planning and repeating conversations or learning rules about verbal and non-verbal behavior; and accommodation strategies, such as doing your best to be helpful. These were used equally by people with an official diagnosis of autism and by others.

There were many motivations to use these strategies, which were harder to maintain when the individual was stressed or fatigued, including social motivation and the desire to develop meaningful relationships. There was also a perception that non-autistic people could "see through" these strategies.

The use of these strategies was related to poor mental health, and autism-related diagnosis and support also appeared to be affected: 47 of the 58 participants with a confirmed diagnosis were diagnosed late in life. ;adulthood. The other 11 were diagnosed before the age of 18.

External environments have affected compensation and people with autism may present themselves as "neurotypical" in some situations, but not in others, say the authors.

Clinicians need to be aware of this when they measure compensation and diagnose autism. Recent evidence suggests that only 40% of British general practitioners – the first point of contact for people seeking a diagnosis – have confidence in the identification of autism spectrum disorders.

Lucy Livingston, lead author, said, "No studies have so far focused on the compensation strategies used by people with autism in social situations. Because they are a barrier to diagnosing autism, increased awareness of clinicians about compensatory strategies will help detect and provide support to people with autism who use them. "

She adds, "This study highlights that compensation is an adaptive response to external societal pressures. This is consistent with the research that people with autism, despite the negative impact on their well-being, are motivated to respond to societal expectations of behavior. "

In one linked comment articleJulia Parish-Morris, Autism Research Center, Philadelphia Children's Hospital, USA, said, "Although many people compensate during social interaction, this exercise can be particularly tiring. and painful for people with autism spectrum disorders.

"This finding raises the question: should subjective enmity be enumerated in the diagnostic criteria for autism spectrum disorder? For example, the DSM-5 could be modified as follows: "The symptoms result in a clinically significant alteration of social, occupational or other important functioning of the current functioning. [-including subjective distress]"."

* Livingston LA, et al. Compensatory strategies under the behavioral surface in autism: a qualitative study. The Lancet, July 2019.

** Parish-Morris J. See the Invisible Realities of Autism. The Lancet, July 2019